This section presents the key findings related to the extent has the Better Access initiative improved health outcomes for people with a mental health disorder.

4.5.1 Summary of perceptions on effectiveness
4.5.2 Better client outcomes
4.5.3 Impact of capped sessions on treatment and outcomes

4.5.1 Summary of perceptions on effectiveness

Overall, stakeholders and interviewees believed that the Better Access initiative has resulted in improved outcomes for clients. However, all service providers and professional groups noted that there had been no formal evaluation of client outcomes and that the quality and effectiveness of services provided were likely to vary across individual practitioners. A few service providers and consumers provided anecdotal evidence of poor outcomes following the provision of treatment under the Better Access initiative. GPs and psychiatrists indicated that feedback from their patients on the helpfulness of services received from AHPs was the primary indicator of the quality of service provided by individual AHPs. This information was used to inform subsequent referrals. Within this context, a number of GPs and psychiatrists reported an informal filtering of referrals to AHPs based on the perception of the GP or psychiatrist of the quality of care provided and a matching of client need to AHP expertise.

Overall, consumers and carers reported high levels of perceived helpfulness of services provided.

4.5.2 Better client outcomes

Generally, service providers and professional groups reported that they believed the Better Access initiative had improved outcomes for clients. They considered that the Better Access initiative was particularly effective for clients with high prevalence, uncomplicated disorders. There was also acknowledgement by groups providing treatment for children and young people that the Better Access initiative had been effective in this cohort, as the improved access to early intervention had assisted in preventing the progression to a more serious illness.

All groups acknowledged that their beliefs about service effectiveness were largely based on anecdotal evidence since there has been no formal evaluation of client outcomes (this will be explored in Component A). Of the 110 consumers rating the helpfulness of the services they received from an AHP in the online survey, 41 per cent reported that the services had made them feel much better, a further 41 per cent reported the services received made them feel somewhat better, 14 per cent felt that the services did not make much difference and 4 per cent reported that the services made them feel worse. Reflective of the reported helpfulness, 85 per cent of 118 respondents reported that, if a family member or friend were experiencing a mental health problem, they would most certainly (66 per cent) or possibly (19 per cent) recommend that they seek a referral to a therapist from their GP through Medicare.

A number of psychiatrists, GP stakeholders and public mental health providers suggested that outcome measures needed to be taken and reported to Medicare in order to determine service effectiveness. The Better Access initiative was viewed as an unprecedented opportunity to inform, develop and strengthen the existing evidence-base for psychological treatments.53 The literature suggests a need to develop an evidence base on the effectiveness of treatments in practice, including those treatments administered by GPs,54 occupational therapists, psychologists and social workers. 55Top of page

In order to gain a more concrete view about client outcomes, two professional groups had recently administered surveys.
  • The APS conducted a survey of 2,223 clients who had received psychological services under the Better Access initiative.56 When asked to indicate the level of improvement they had experienced as a result of psychological treatment, 90 per cent of respondents indicated that treatment had resulted in significant (45 per cent) or very significant (45 per cent) improvement. There was no significant difference in perceived effectiveness between clients from different geographical location, socio-economic groups, client gender or age group.

  • The Australian College of Clinical Psychologists (ACCP) reported that a survey of its own members demonstrated similar results (as provided during the consultation process). According to the ACCP reported survey, 85 per cent to 99 per cent of patients reported improvement in psychological well being following treatment through the Better Access initiative. The findings from the APS and ACCP surveys are similar to the results of the online survey, reported above.
Contrary to the improvements generally reported by consumers and indicated in the APS survey, several stakeholders and consumers expressed the view that the Better Access initiative had not improved client outcomes.

As indicated in relation to access to mental health services, a small number of psychiatrists expressed concern that the Better Access initiative had resulted in patients receiving inappropriate treatment from AHPs and experiencing delays in referral to a psychiatrist, resulting in a poorer outcome for clients. This perception was expressed by a minority of psychiatrists and was not in all cases a criticism of the Better Access initiative as an initiative, but reflective of the range of skills and expertise available within the community.

Similarly, whilst largely supportive of the Better Access initiative, a private hospital reported that they had heard of people who had not been well managed through the Better Access initiative-funded services having a crisis and requiring admission. Anecdotal examples of this kind were also reported by a minority of public providers. Generally, comments of this nature were reflective of a recognition of the range of complexity of patients (i.e. some clients do have complex conditions and will require admission) and that, in some instances, the patient could have been managed better by the AHP. Only for the sub group of stakeholders and interviewees critical of the Better Access initiative as a model of care was this presented as a criticism of the model itself.

Concerns about the effectiveness of the Better Access initiative for particular client groups were also raised. One state and territory health department expressed doubts about the outcomes achieved for Aboriginal and Torres Strait Islander clients or those from culturally or linguistically diverse backgrounds. It was also argued by clinical psychologists that the Better Access initiative was not effective for people with low prevalence and more complex disorders requiring longer interventions57. The queried effectiveness of the Better Access initiative in treating special needs groups was also reflected in the online survey of GPs, psychiatrists and paediatricians and survey of allied health providers. The surveys found lower levels of agreement that the Better Access initiative resulted in improved outcomes for special needs groups than it did for people with anxiety and depression related disorders, older people and children and young people. The results from the surveys are summarised below and in table 4.
  • Ninety per cent of respondents agreed that the Better Access initiative has contributed to improved outcomes for people with anxiety or depression related disorders, with only six per cent disagreeing and four per cent unsure.

  • Sixty five per cent and 64 per cent agreed that improved outcomes are being achieved for older people and for children and young people respectively, with only nine and ten per cent disagreeing.

  • Fifty per cent agreeing improved outcomes are being achieved for people with substance abuse disorders and 15 per cent disagreeing.

  • Only sixteen per cent agreeing that improved outcomes are being achieved for Aboriginal and Torres Strait islander people or people living in remote communities.

  • Approximately one-third of respondents agreeing that improved outcomes are being achieved for people living in rural communities (32 per cent) and people from culturally and linguistically diverse communities (27 per cent).
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Table 6: Summary of GP and AHP response in relation to outcomes

Table 6 is separated into 3 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.

Table 6a: AHP survey - summary of response in relation to outcomes

To what extent do you agree with the following statement: Better Access has contributed to:AgreeDisagreeUnsureValid responses (N)
improved mental health outcomes for people with anxiety or depression related disorders
95%
1%
3%
329
improved mental health outcomes for people with substance use disorders
58%
5%
36%
327
improved mental health outcomes for Aboriginal and Torres Strait Islander people
18%
9%
73%
326
improved mental health outcomes for people living in rural communities
36%
8%
56%
326
improved mental health outcomes for people living in remote communities
20%
9%
72%
327
improved mental health outcomes for people from culturally and linguistically diverse backgrounds
32%
7%
61%
326
improved mental health outcomes for children and young people
70%
4%
26%
328
improved mental health outcomes for older people (i.e. those aged 65 years)
69%
3%
28%
324
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Table 6b: GPs, psychiatrists and paediatricians survey - summary of response in relation to outcomes

To what extent do you agree with the following statement: Better Access has contributed to:AgreeDisagreeUnsureValid responses (N)
improved mental health outcomes for people with anxiety or depression related disorders
82%
14%
5%
200
improved mental health outcomes for people with substance use disorders
37%
31%
32%
194
improved mental health outcomes for Aboriginal and Torres Strait Islander people
11%
23%
66%
194
improved mental health outcomes for people living in rural communities
24%
19%
57%
194
improved mental health outcomes for people living in remote communities
10%
19%
71%
193
improved mental health outcomes for people from culturally and linguistically diverse backgrounds
19%
23%
58%
193
improved mental health outcomes for children and young people
54%
20%
25%
197
improved mental health outcomes for older people (i.e. those aged 65 years)
58%
17%
24%
195

Table 6c: Both surveys - summary of response in relation to outcomes

To what extent do you agree with the following statement: Better Access has contributed to:AgreeDisagreeUnsureValid responses (N)
improved mental health outcomes for people with anxiety or depression related disorders
90%
6%
4%
529
improved mental health outcomes for people with substance use disorders
50%
15%
35%
521
improved mental health outcomes for Aboriginal and Torres Strait Islander people
16%
14%
71%
520
improved mental health outcomes for people living in rural communities
32%
12%
56%
520
improved mental health outcomes for people living in remote communities
16%
13%
71%
520
improved mental health outcomes for people from culturally and linguistically diverse backgrounds
27%
13%
60%
519
improved mental health outcomes for children and young people
64%
10%
26%
525
improved mental health outcomes for older people (i.e. those aged 65 years)
65%
9%
26%
519
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4.5.3 Impact of capped sessions on treatment and outcomes

Most allied health providers argued that the limited number of sessions reduced the effectiveness of the Better Access initiative for those with complicated, complex disorders58. There was also a variation in the perception of different providers as to the number of sessions that were available and what constituted 'exceptional circumstances' for the purposes of receiving 18 sessions.

The consultations suggest that there was also variation across providers as to how the defined target group and number of sessions influenced their practice. Some (slightly more than half) complied with the intent of the Better Access initiative and targeted services to clients who would improve within 6-12 sessions.

Others (a significant minority) continued to work within the same population and model of care they had historically used and provided the number of sessions they assessed the patient to require. They were more inclined to utilise the full 18 sessions available through the Better Access initiative.

The overall perception to emerge from the consultations with AHPs was that the limited number of sessions was a consideration in determining the treatment intervention.

Footnotes

53 Carey, Timothy A. Rickwood, Debra J. Baker, Keith. 'What does $27,650,523.80 worth of evidence look like?' Centre for Allied Psychology, University of Canberra, (2009) p 17.
54 Grant A Blashki, Leon Piterman, Graham N Meadows, David M Clarke, Vasuki Prabaharan, Jane M Gunn and Fiona K Judd, "Impact of an educational intervention on general practitioners' skills in cognitive behavioural strategies: a randomised controlled trial", Medical Journal of Australia (2008) Vol. 188 P. S129.
55 Carey et al (2009).
56 APS (2008).
57 See note 12 in section 4.2.2.
58 As discussed in note 12 in section 4.2.2 the intent of the Better Access initiative is not to provide treatment to individuals with complicated and complex disorders. The average number of sessions provided through the Better Access initiative is five sessions per individual treated (Source: DOHA advice 14 September 2009).